Pancreatic cancer often doesn't cause symptoms until it has spread. Because of this, many people aren't diagnosed until the cancer has advanced. If you have metastatic pancreatic ductal adenocarcinoma (mPDAC), it means the cancer has spread beyond the pancreas and isn't considered curable.
Getting an mPDAC diagnosis can be overwhelming and bring up a lot of difficult emotions. While treatments may help slow the cancer's growth and improve your quality of life, looking after your mental health and emotional well-being is also an important part of care.
Understanding the Emotional Impact of an mPDAC Diagnosis
The period between diagnosis and treatment can be especially hard for patients and their families, says Alicia Remy, MSW, LICSW, a senior clinical social worker in the gastrointestinal cancer department at Dana-Farber Cancer Institute.
"You just don't know what to expect at times … your world is upside down," she says. "Even with a life-altering diagnosis like mPDAC, some people feel a little bit more at ease once they know what they're dealing with, have a treatment plan in place, and can meet with their oncologist and care team."
Everyone's experience with cancer is different. Some people say a diagnosis helps them appreciate everyday moments more deeply. Others may have a hard time taking their mind off of cancer.
Some other common emotions after a pancreatic cancer diagnosis include:
- Anger
- Shock
- Sadness
- Guilt
- Frustration
- Grief
- Hopelessness
- Feeling numb
- Fear or uncertainty
- Confusion
When talking about pancreatic cancer and mental health, "something we often forget is that it's not only the diagnosis, but the treatments that tend to be very aggressive and can affect physical and mental health," says Jordan Cloyd, MD, an associate professor of surgery at Ohio State University Wexner Medical Center, James Comprehensive Cancer Center. "It's important to have a degree of emotional honesty with yourself, to acknowledge what you're feeling and to have open communication with your health care provider about it."
Recognizing Mental Health Needs
It's normal to have bad days where you feel anxious or down, but if these feelings don't go away, you may have a more serious mental health problem that requires extra support.
Pancreatic cancer and anxiety
Anxiety is your body's natural response to stress. If you have mPDAC, you might worry about things like treatment, pain, your loved ones, and the future. But when those worries start to become constant or overwhelming, it can affect both your emotional and physical health.
During stressful situations, your body releases a hormone called adrenaline, which triggers your "fight or flight" response. This response can help protect you in dangerous situations, but if you're feeling anxious all the time, it can turn into a vicious cycle, where a worry causes symptoms and symptoms cause more worries.
These symptoms may include:
- A constant feeling something bad is going to happen
- Feeling very upset or negative
- Feeling like you're not able to stop worrying
- Shortness of breath
- Sweating
- A racing heartbeat
- Shaky hands or a lump in your throat
- Chest or abdominal (belly) pain
- Tense muscles or lightheadedness
- Panic attacks
- Trouble sleeping
Pancreatic cancer and depression
Receiving a life-changing diagnosis like mPDAC can bring up feelings of sadness and hopelessness, but this is different from being depressed. Depression is a chemical imbalance in the brain that affects your mood, energy, and ability to do day-to-day tasks. It can be brought on by physical or emotional stress, including cancer.
Depression is more common in people with pancreatic cancer than in people with other types of gastrointestinal cancer. It's estimated that as many as 71% of people who get pancreatic cancer also deal with depression.
Some research suggests there's a link between pancreatic cancer and depression even before the disease is diagnosed. While the stress of treatment and uncertainty can certainly contribute to depression, physical changes in the body may also play a role. Your body's early response to cancer causes inflammation, which can make you feel tired, change your sleep schedule, and lower your appetite – all things that can affect mental health. The pancreas also helps regulate hormones involved in mood, which could be affected if the organ isn't working properly due to cancer.
Some of the most common symptoms of depression include:
- Feelings of sadness or emptiness that don't go away
- Sleep problems, including trouble sleeping or sleeping too much
- Loss of interest in activities you used to enjoy
- Loss of appetite
- Fatigue or low energy
- A hard time concentrating
- Thoughts of self-harm or suicide
If your cancer diagnosis or treatment starts to feel overwhelming, you may have thoughts about wanting to die. Doctors may refer to these as passive suicidal thoughts. While these thoughts can be frightening, they are different from actively wanting to harm yourself. If you are thinking about hurting yourself or taking your own life, it's important to get medical help right away.
When and How to Seek Help
Many of the symptoms of anxiety and depression – like weight loss, changes in appetite, and lack of energy – overlap the side effects of certain cancer treatments. If your symptoms start to interfere with your ability to function day-to-day, you should talk to your doctor about finding extra support, Remy says.
"I think it's always good to get in touch with somebody a little earlier, rather than later, if you're struggling," she says.
Managing Day-to-Day Emotional Well-Being
You don't have to cope with the emotional effects of mPDAC on your own. Mental health and emotional support are important parts of cancer care. Your doctor can connect you with different services that can help.
These may include:
- Social workers. Hospital social workers can be a good first point of contact for helping you access other support services. This might include transportation, getting financial help, finding support groups, or connecting you with other mental health providers.
- Grief counselors. Grief counselors can help you and your loved ones process different kinds of loss that come with having cancer, including changes in independence, relationships, work, and future plans.
- Chaplains. Chaplains are trained spiritual advisers who give emotional, spiritual, or religious support to cancer patients and their families. Hospital chaplains support people of all faiths, including those who aren't religious.
- Psychologists. Psychologists are trained to offer different types of therapy that can help you manage different emotions and cope with stress. One common approach used in cancer care is cognitive behavior therapy (CBT), which can help you recognize unhelpful thought patterns and develop healthier coping strategies.
- Specialized therapists. You may also benefit from an alternative therapy, like art therapy, music therapy, or intimacy and relationship counseling. These approaches can help you express your emotions, lower stress, and navigate challenges you may have with a loved one.
- Integrative therapies. Wellness-focused therapies, like reflexology, acupuncture, and massage therapy, can help you manage stress, anxiety, and other symptoms related to cancer treatment. These are usually used alongside medical care.
- Psychiatrists. Psychiatrists are medical doctors who specialize in mental health. They can diagnose conditions like anxiety or depression and prescribe medications to help manage your symptoms when needed.
Self-care tips
Finding time for self-care during cancer treatment can be a challenge, especially on harder days. While self-care won't remove the challenges of living with mPDAC, creating routines that support your emotional well-being may help you feel less stressed, improve your mood, and give you a greater sense of comfort.
People with mPDAC "experience a really big shift in their reality, their independence, their level of self-esteem, and their wellness," Remy says. "Being able to take back some control in little ways – such as making decisions for themselves, being able to take a walk on their own, or being able to have as much independence as possible – is really important."
And self-care looks a bit different for everyone. "Strategies might also look slightly different each day," Cloyd says.
Possible self-care strategies might include:
- Light exercise, like walking or swimming, which may boost your mood and help with fatigue
- Relaxation exercises, like meditation, mindfulness, or deep breathing. Insight Timer is an app that includes short meditations for patients and family members. There are also many free options available on YouTube.
- Creative activities, like art, music, or poetry
- Spending time with friends or family
- Eating healthy meals when possible
- Prayer or other spiritual activities
Building a Support System
Living with mPDAC may feel isolating at times, but having people around you who care can provide a sense of comfort, stability, and strength. Building a support network can also help meet different needs – emotional, practical, and medical – by leaning on the strengths of different people and services.
A well-balanced support network may include:
- Family members
- Friends
- Health care workers
- Therapists and counselors
- Peer support groups
How to join a community and peer support group
Joining a support group is a helpful way to connect with others who understand what you're going through. These groups are usually available in person and online, and they can give you a space to share your experience, get advice from fellow patients, and offer support.
Talk to your health care team to see if they can connect you with a support group. You can also find more information on joining a pancreatic cancer support group through the Pancreatic Cancer Action Network (PanCan).
Support for Caregivers and Loved Ones
Watching someone you love go through mPDAC can be incredibly difficult. It's common for caregivers to feel helpless and want to do more, even if there's little they can directly change, Remy says.
One of the best things caregivers can do is keep open communication with the person they're supporting, she says. Asking what feels helpful – and what doesn't – can make day-to-day support more meaningful and lower stress for both people.
Caregiver well-being is often overlooked, but supporting your own mental health is an important part of the caregiving role, Cloyd says. This may include:
- Speaking with a therapist
- Connecting with a social worker
- Joining a caregiver support group
- Remembering to take regular breaks and time for yourself
"On a plane, you put your own oxygen mask on before your child's. You have to be able to save yourself before you can save others," Cloyd says. "This is the same. Prioritizing self-care is going to help you be a better caregiver and offer better support for your loved ones."
Show Sources
Photo Credit: E+/Getty Images
SOURCES:
Alicia Remy, licensed independent clinical social worker; senior clinical social worker, gastrointestinal cancer department, Dana-Farber Cancer Institute, Boston.
Cancers: "Depression as a Prodromal Symptom of Pancreatic Cancer: A Narrative Review."
Cancer Research UK: "Causes of depression," "Coping and support when you have pancreatic cancer," "Depression and cancer," "Fear, anxiety, panic and cancer," "Symptoms of depression."
Let's Win Pancreatic Cancer: "Mental Health and Pancreatic Cancer," "The Link Between Depression and Pancreatic Cancer."
Moffitt Cancer Center: "What Is Metastatic Pancreatic Cancer?"
National Pancreatic Cancer Foundation: "Building a Support System for Pancreatic Cancer Patients," "Support Mental Health for Cancer Patients."
Pancreatic Cancer UK: "Anxiety and depression."
Jordan Cloyd, MD, associate professor of surgery, Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, Ohio.
